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Acad Med. 2014 Jan;89(1):94-106. doi: 10.1097/ACM.0000000000000050.

Comparing teaching versus nonteaching hospitals: the association of patient characteristics with teaching intensity for three common medical conditions.

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Dr. Shahian is professor of surgery, Harvard Medical School, and vice president, Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts. Ms. Liu is senior research analyst, Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts. Dr. Meyer is executive vice president for population health and chief clinical officer, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Dr. Normand is professor of health care policy, Harvard Medical School, and professor of biostatistics, Harvard School of Public Health, Boston, Massachusetts.



To quantify the role of teaching hospitals in direct patient care, the authors compared characteristics of patients served by hospitals of varying teaching intensity.


The authors studied Medicare beneficiaries ≥ 66 years old, hospitalized in 2009-2010 for acute myocardial infarction, heart failure, or pneumonia. They categorized hospitals as nonteaching, teaching, or Council of Teaching Hospitals and Health Systems (COTH) members and performed secondary analyses using intern and resident-to-bed ratios. The authors used descriptive statistics, adjusted odds ratios, and linear propensity scores to compare patient characteristics among teaching intensity levels. They supplemented Medicare mortality model variables with race, transfer status, and distance traveled.


Adjusted for comorbidities, black patients had 2.44 (95% confidence interval [CI] 2.36-2.52), 2.56 (95% CI 2.51-2.60), and 2.58 (95% CI 2.51-2.65) times the odds of COTH hospital admission compared with white patients for acute myocardial infarction, heart failure, and pneumonia, respectively. For patients transferred from another hospital's inpatient setting, the corresponding adjusted odds ratios of COTH hospital admission were 3.99 (95% CI 3.85-4.13), 4.60 (95% CI 4.34-4.88), and 4.62 (95% CI 4.16-5.12). Using national data, distributions of propensity scores (probability of admission to a COTH hospital) varied markedly among teaching intensity levels. Data from Massachusetts and California illustrated between-state heterogeneity in COTH utilization.


Major teaching hospitals are significantly more likely to provide care for minorities and patients requiring transfer from other institutions for advanced care.Both are essential to an equitable and high-quality regional health care system.

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